Kyangwali — Around 8pm one January night, the bullets started flying through the village of Blukwa, in the Democratic Republic of Congo's Ituri Province. It was just one incident in a wave of violence that has flared up in the region in recent months, forcing tens of thousands of people to flee.
As with conflicts elsewhere in Congo, rape and other forms of sexual violence feature prominently in the Ituri attacks, in which hundreds of people have been killed.
But for many women and girls who have fled to Uganda, care for their physical and psychological wounds is hard to come by - even when they are willing to seek it out, overlooking the stigma often attached to victims of sexual violence.
Support includes identifying survivors; providing access to psychosocial, medical, and legal services; training health workers in clinical management of rape; and supplying post-rape kits to health facilities.
As Dismas Nkunda, the executive director of Atrocities Watch Africa, noted, Uganda is known for its "robust" refugee regime, one that now accommodates around 1.4 million people who have fled neighbouring countries.
"Providing appropriate support for survivors of rape is mandatory for any refugee protection regime anywhere in the world, so there should be no excuse whatsoever for failure to support these victims," he said.
Francisca Vigaud-Walsh, senior advocate for women and girls at Refugees International, said the reasons for the unmet needs are clear. "It is unsurprising that there is a limited number of services for rape survivors arriving from Ituri into Uganda," she said. "The humanitarian response in Uganda is woefully underfunded, and limited resources are now being diverted to the cholera response," she said.
Speaking recently from Kyangwali, a sprawling Ugandan settlement for refugees, one former resident of Blukwa recalled the January night she fled. The woman, who did not want to use her name, said she and her husband heard shooting and he went to investigate. "We should run to save our lives," he told her as he returned to the house. "He grabbed our son and ran with him," she recalled. "I tried to follow, but I lost touch. It was dark.
"I couldn't call them, so I decided to go my separate way to hide. While I was in the bush, I heard and saw two people coming towards my direction. They had guns; I knew I was dead.
"I tried to plead with them to spare me. They couldn't listen. They undressed and raped me. One covered my mouth while the other raped me. After he finished, his colleague came and did the same. They raped me without any mercy. They threatened to kill me if I ever shouted.
"After raping me, they left. I remained in the bush with a lot of pain. When I returned back home in the morning I thought I would find my husband and son... They were no more. They had been killed the same night I was terribly raped."
Exhausted and hungry, she said she managed the two-day walk to the shores of Lake Albert and boarded a boat to Uganda, where some 50,000 people from Ituri have sought refuge this year.
According to an official at a Ugandan reception centre cited by the aid agency CARE last month, nine out of every 10 women arriving had been raped, sometimes more than once, and sometimes by gangs - both inside Congo and as they fled to Uganda.
"All these women who make it here were victims of rape and other forms of gender based violence," said the unnamed official.
Addressing the gap in aid for victims of sexual violence, Vigaud-Walsh said: "In part, Uganda and its humanitarian partners simply cannot keep up with the unrelenting number of refugees that continue to stream in from the DRC and South Sudan, not to mention Burundians that have fled persecution into Uganda. The OPM (Office of the Prime Minister) scandal, with regards to refugee registration and exploitation, has not been helpful either - it has shaken the will and trust of international donors."
"Nonetheless, international donors must recognise that joint [UN refugee agency] - OPM efforts are underway to redress these failures," she added. "The reduction in humanitarian dollars to Uganda will only serve to punish refugees. More financing is needed, in particular to allow for services for rape survivors to be prioritised for women and girls arriving from Ituri, DRC, as [for] those who continue to arrive from South Sudan."
Alain Sibenaler, the Uganda country representative of the UN Population Fund, which works in partnership with CARE in assisting survivors of sexual violence in Kyangwali, said: "It is not easy estimating the magnitude of the problem because the majority of the cases go unreported, given the shame associated with rape."
The suffering of survivors extends beyond the crime itself, noted CARE Country Director Delphine Pinault. "Despite the prevalence of rape and other forms of sexual violence, at the community level stigma surrounding being a survivor still persists, including being ridiculed, rejected, and isolated as a result of the shame," she said.
CARE is setting up centres in Kyangwali to provide counselling and group activities to survivors of gender-based violence.
"Through a set of activities that brings women together in a rather relaxed fashion, they will be supported to tell their stories and process the past," Pinault said.
She added that there were too few professional counsellors and specialists for traumatised children to allow survivors to speak in their own language.
As previously reported by IRIN, a cholera outbreak among new arrivals in Uganda has reduced the funding and resources needed to respond to cases of gender-based violence.
"I am alone and traumatised. How can I live without my husband and son? It could have been better if I was killed with them."
And as a 17-year-old from the Ituri village of Lewi explained, individual needs are great.
"I am traumatised," said the woman, who asked that her name not be used. "I am physically, emotionally, and psychologically affected. I can't forget the terrible experience. Why did they have to rape me like that? It was so painful and terrifying."
Primary healthcare facilities in the 17 villages that make up Kyangwali are very few in number and poorly supplied. The nearest referral hospital is 80 kilometres away. At the national level, Uganda languishes near the bottom of global healthcare league tables.
These shortcomings are all too evident for the survivor from Blukwa, who lost her husband and son. She says she is now incontinent, suffers pains in her abdomen, and that a whitish liquid is secreted from her genital area.
"I was referred to the health facility for checkups and treatment," she said. "Unfortunately, I didn't get proper medical treatment. I was given some drugs that didn't help."
"I am alone and traumatised. How can I live without my husband and son? It could have been better if I was killed with them," she said.